Re-bleeding events in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

Abstract

Patients with OGIB despite a negative capsule endoscopy have a significant re-bleeding risk; therefore, these patients require an extended follow-up strategy.

Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding

“…Remarkably, the majority of re-bleeding episodes (81.3%) occurred within the first 2 years after VCE examination, while the cumulative risk of re-bleeding raised from 12.9% at 1, to 25.6% at 3 and to 31.5% at 5 years, respectively (31); this finding being verified by other authors (29). In keeping with the findings of previous reports (25,32), the median time until first rebleeding event was 15 months, underlying the value of patient monitoring for at least the first 2 years post negative VCE exam and perhaps later on, as the interquartile range for the time lag to re-bleeding was between 2 and 33 months (31).…”

“…In the study by Min et al (37), 66/116 patients who discontinued anticoagulant medication after VCE demonstrated lower re-bleeding rate; interestingly, use of anticoagulants before and after VCE was not associated with re-bleeding, overall. Similar to previous reports, Cúrdia Gonçalves et al (62) found only marginal association between anticoagulants use and re-bleeding episode, while another study identified anticoagulant use as predictor of future re-bleeding events (HR: 3.9; 95% CI, 1.5-9.9; P=0.004) (31). However, since all these studies were powered only for the primary endpoint and investigation for predictors of re-bleeding were regarded merely a secondary one, the possibility of a type II error cannot be excluded.…”

“…Authors concluded that VCE negative patients should undergo regular follow-up, whilst being mindful that the bleeding may not originate from the small bowel. Park et al (34), in a Korean single center retrospective analysis of 57 consecutive patients followed for 31.7 months, found a comparable re-bleeding rate between patients with positive and negative VCE exams (34.8% vs. 35.7%, P=0.989), suggesting that this might be due to a 19.6% miss rate of VCE for small bowel lesions, in the setting of equal small-bowel transit time (SBTT) during OGIB between re-bleeders and non-re-bleeders (31). In another Korean study, Kim et al (35) reported a re-bleeding rate of 26.7% in patients with negative VCE without subsequent treatment and 21.2% in positive VCE without specific treatment, respectively (P=0.496).…”

“…Physicians should also maintain a high level of suspicion in case of older patients since data converge to the conclusion that advanced age is a an independent factor for re-bleeding (27,28,31,52,63). This might be linked to the increased prevalence of angiodysplasia among older individuals and the high incidence of angiodysplasia when chronic kidney disease is present (2,64).…”

Diagnostic and therapeutic considerations for obscure gastrointestinal bleeding in patients with chronic kidney disease

“…In the CKD cohort, the sensitivity was 88.9%, compared to the 30% sensitivity of colonoscopy [62] Docherty et al, 2015 Assessed the diagnostic yield of VCE in evaluating OGIB in patients with CKD. 51% had findings on VCE, and 33.3% had angiodysplasia as the cause of bleeding [35] Magalhaes-Costa et al, 2015 Evaluated the rate of recurrent OGIB after a negative VCE and found that patients with CKD had an increased HR of 3.498 for re-bleeding on univariate analysis (95% CI=1.265-9.671, P=0.016) [52] without active bleeding (92.3% vs. 12.9%). In those with prior episodes, the earlier the VCE was done after the cessation of bleeding, the higher the yield [33].…”